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Article: Long-Term Prognosis of Patients With Coronary Microvascular Disease Using Stress Perfusion Cardiac Magnetic Resonance

TitleLong-Term Prognosis of Patients With Coronary Microvascular Disease Using Stress Perfusion Cardiac Magnetic Resonance
Authors
Keywordscoronary microvascular disease
MPRI
prognosis
stress CMR
Issue Date2020
PublisherElsevier Inc. The Journal's web site is located at http://imaging.onlinejacc.org/journal.aspx
Citation
JACC: Cardiovascular Imaging, 2020, v. 14 n. 3, p. 602-611 How to Cite?
AbstractOBJECTIVES This study investigated the prognosis of coronary microvascular disease (CMD) as determined by stress perfusion cardiac magnetic resonance (CMR) in patients with ischemic symptoms but without significant coronary artery disease (CAD). BACKGROUND Patients with CMD have poorer prognosis with various cardiac diseases. The myocardial perfusion reserve index (MPRI) derived from noninvasive stress perfusion CMR has been established to diagnose microvascular angina with a threshold MPRI <1.4. The prognosis of CMD as determined by MPRI is unknown. METHODS Chest pain patients without epicardial CAD or myocardial disease from January 2009 to December 2017 were retrospectively included from 3 imaging centers in Hong Kong (H K). Stress perfusion CMR examinations were performed using either adenosine or adenosine triphosphate. Adequate stress was assessed by achieving splenic switch-off sign. Measurement of MPRI was performed in all stress perfusion CMR scans. Patients were followed for major adverse cardiovascular events defined as all-cause death, acute coronary syndrome (ACS), epicardial CAD development, heart failure hospitalization and non-fatal stroke. RESULTS A total of 218 patients were studied (mean age 59 +/- 12 years; 49.5% male) and the average MPRI of that cohort was 1.56 +/- 0.33. Females and a history of hyperlipidemia were predictors of lower MPRI. Major adverse cardiovascular events (MACE) occurred in 15.6% of patients during a median follow-up of 5.5 years (interquartite range: 4.6 to 6.8 years). The optimal cutoff value of MPRI in predicting MACE was found with a threshold MPRI <= 1.47. Patients with MPRI <= 1.47 had three-fold increased risk of MACE compared with those with MPRI >1.47 (hazard ratio [HR]: 3.14; 95% confidence interval [CI]: 1.58 to 6.25; p = 0.001). Multivariate Cox regression after adjusting for age and hypertension demonstrated that MPRI was an independent predictor of MACE (HR: 0.10; 95% CI: 0.03 to 0.34; p < 0.001). CONCLUSIONS Stress perfusion CMR-derived MPRI is an independent imaging marker that predicts MACE in patients with ischemic symptom and no overt CAD over the medium term. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
DescriptionHybrid open access
Persistent Identifierhttp://hdl.handle.net/10722/295326
ISSN
2023 Impact Factor: 12.8
2023 SCImago Journal Rankings: 4.636
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorZHOU, W-
dc.contributor.authorLee, JCY-
dc.contributor.authorLeung, ST-
dc.contributor.authorLai, A-
dc.contributor.authorLee, TF-
dc.contributor.authorChiang, JB-
dc.contributor.authorCheng, YW-
dc.contributor.authorChan, HL-
dc.contributor.authorYiu, KH-
dc.contributor.authorGoh, VKM-
dc.contributor.authorPennell, DJ-
dc.contributor.authorNg, MY-
dc.date.accessioned2021-01-11T13:58:31Z-
dc.date.available2021-01-11T13:58:31Z-
dc.date.issued2020-
dc.identifier.citationJACC: Cardiovascular Imaging, 2020, v. 14 n. 3, p. 602-611-
dc.identifier.issn1936-878X-
dc.identifier.urihttp://hdl.handle.net/10722/295326-
dc.descriptionHybrid open access-
dc.description.abstractOBJECTIVES This study investigated the prognosis of coronary microvascular disease (CMD) as determined by stress perfusion cardiac magnetic resonance (CMR) in patients with ischemic symptoms but without significant coronary artery disease (CAD). BACKGROUND Patients with CMD have poorer prognosis with various cardiac diseases. The myocardial perfusion reserve index (MPRI) derived from noninvasive stress perfusion CMR has been established to diagnose microvascular angina with a threshold MPRI <1.4. The prognosis of CMD as determined by MPRI is unknown. METHODS Chest pain patients without epicardial CAD or myocardial disease from January 2009 to December 2017 were retrospectively included from 3 imaging centers in Hong Kong (H K). Stress perfusion CMR examinations were performed using either adenosine or adenosine triphosphate. Adequate stress was assessed by achieving splenic switch-off sign. Measurement of MPRI was performed in all stress perfusion CMR scans. Patients were followed for major adverse cardiovascular events defined as all-cause death, acute coronary syndrome (ACS), epicardial CAD development, heart failure hospitalization and non-fatal stroke. RESULTS A total of 218 patients were studied (mean age 59 +/- 12 years; 49.5% male) and the average MPRI of that cohort was 1.56 +/- 0.33. Females and a history of hyperlipidemia were predictors of lower MPRI. Major adverse cardiovascular events (MACE) occurred in 15.6% of patients during a median follow-up of 5.5 years (interquartite range: 4.6 to 6.8 years). The optimal cutoff value of MPRI in predicting MACE was found with a threshold MPRI <= 1.47. Patients with MPRI <= 1.47 had three-fold increased risk of MACE compared with those with MPRI >1.47 (hazard ratio [HR]: 3.14; 95% confidence interval [CI]: 1.58 to 6.25; p = 0.001). Multivariate Cox regression after adjusting for age and hypertension demonstrated that MPRI was an independent predictor of MACE (HR: 0.10; 95% CI: 0.03 to 0.34; p < 0.001). CONCLUSIONS Stress perfusion CMR-derived MPRI is an independent imaging marker that predicts MACE in patients with ischemic symptom and no overt CAD over the medium term. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.-
dc.languageeng-
dc.publisherElsevier Inc. The Journal's web site is located at http://imaging.onlinejacc.org/journal.aspx-
dc.relation.ispartofJACC: Cardiovascular Imaging-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectcoronary microvascular disease-
dc.subjectMPRI-
dc.subjectprognosis-
dc.subjectstress CMR-
dc.titleLong-Term Prognosis of Patients With Coronary Microvascular Disease Using Stress Perfusion Cardiac Magnetic Resonance-
dc.typeArticle-
dc.identifier.emailYiu, KH: khkyiu@hku.hk-
dc.identifier.emailNg, MY: myng2@hku.hk-
dc.identifier.authorityYiu, KH=rp01490-
dc.identifier.authorityNg, MY=rp01976-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1016/j.jcmg.2020.09.034-
dc.identifier.pmid33248966-
dc.identifier.scopuseid_2-s2.0-85097464048-
dc.identifier.hkuros320858-
dc.identifier.volume14-
dc.identifier.issue3-
dc.identifier.spage602-
dc.identifier.epage611-
dc.identifier.isiWOS:000632508800011-
dc.publisher.placeUnited States-

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